Provider Demographics
NPI:1457607004
Name:SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-632-4468
Mailing Address - Street 1:8100 S. WALKER AVENUE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9404
Mailing Address - Country:US
Mailing Address - Phone:405-632-4468
Mailing Address - Fax:405-631-4964
Practice Address - Street 1:2403 W WRANGLER BLVD
Practice Address - Street 2:STE A
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-1900
Practice Address - Country:US
Practice Address - Phone:405-382-4939
Practice Address - Fax:405-631-4964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-01
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6714610006Medicare NSC